Nielsen Torsten Grønbech, Miller Lene Lindberg, Mygind-Klavsen Bjarne, Lind Martin
Orthopedic Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
J Exp Orthop. 2020 Jun 27;7(1):45. doi: 10.1186/s40634-020-00264-4.
To evaluate if High-volume Image-guided Injection (HVIGI)-treatment for chronic mid-portion Achilles tendinopathy (AT) improve function and reduce pain at 12-months follow-up.
Patients with resistant mid-portion AT who failed to improve after a three-month eccentric loading program were included in the study. Maximal tendon thickness was assessed with ultrasound. All patients were injected with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40 mg/mL) and 40 mL of 0.9% NaCl saline solution under real-time ultrasound-guidance and high pressure. All outcome measures were recorded at baseline and 12 months. A standardized eccentric rehabilitation protocol was prescribed after HVIGI-treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment-Achilles tendon questionnaire (VISA-A) and statistically analyses were performed.
The study included 30 single treatment HVIGI procedures in AT in 28 patients (23 men, 5 women) with a mean age of 45.1 (range 16-63). The mean duration of symptoms before HVIGI was 37 months. The baseline VISA-A score of 50 ± 15 (range 14-74) improved to 61 ± 21 (range 31-94) after 1 year (p = 0.04). Of the 30 AT procedures 10 patients (11 AT) were not satisfied after the initial HVIGI procedure. Of these, 8 patients (9 AT) needed additional HVIGI and two patients needed surgery. Of the remaining 18 patients (19 AT), 10 patients had more than a 10-point improvement in the VISA-A score after 1 year.
In this retrospective case-study, only 10 patients (33%) did benefit of a single HVIGI treatment at 12-months and an 11-point significant improvement was seen at on the VISA-A score.
评估高容量图像引导注射（HVIGI）治疗慢性跟腱中部肌腱病（AT）在12个月随访时是否能改善功能并减轻疼痛。
研究纳入了在为期三个月的离心负荷训练后仍未改善的顽固性跟腱中部AT患者。用超声评估最大肌腱厚度。所有患者在实时超声引导和高压下注射10毫升0.5%的利多卡因、0.5毫升曲安奈德（40毫克/毫升）和40毫升0.9%的氯化钠盐水溶液。所有结局指标在基线和12个月时记录。HVIGI治疗后规定了标准化的离心康复方案。用维多利亚运动评估-跟腱问卷（VISA-A）评估临床结局并进行统计学分析。
该研究包括对28例患者（23例男性，5例女性）的30例AT单次治疗HVIGI手术，平均年龄45.1岁（范围16 - 63岁）。HVIGI前症状的平均持续时间为37个月。1年后，基线VISA-A评分为50±15（范围14 - 74）改善至61±21（范围31 - 94）（p = 0.04）。在30例AT手术中，10例患者（11处AT）在初次HVIGI手术后不满意。其中，8例患者（9处AT）需要额外的HVIGI，2例患者需要手术。在其余18例患者（19处AT）中，10例患者在1年后VISA-A评分改善超过10分。
在这项回顾性病例研究中，仅10例患者（33%）在12个月时从单次HVIGI治疗中获益，且VISA-A评分有11分的显著改善。
